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Aortic Stenosis

What is Aortic Stenosis?

Aortic stenosis is a condition where the aortic valve becomes stiff and does not open properly. The aortic valve is one of the four valves in the heart that prevents blood from going backward. When the aortic valve does not open properly, the pressures within the heart become high.

What are the symptoms of Aortic Stenosis?

Many patients with aortic stenosis do not experience symptoms. However, patients with aortic stenosis that has become severe might experience shortness of breath with exertion, chest pain with exertion, a feeling of faintness or dizziness with exertion, or outright fainting.

What causes Aortic Stenosis?

Aortic stenosis is a progressive degenerative disease of the valve. Some patients are born with a valve that is not completely normal. Those "bileaflet" valves have a tendency to develop stiffening and do not open well. In most patients, aortic stenosis occurs as a result of the gradual buildup of calcium on the valves. That buildup results from cholesterol and inflammation. If the buildup becomes severe, the valves do not open properly. Patients with rheumatic heart disease or other conditions with significant inflammation can also develop aortic stenosis.

What is the treatment for Aortic Stenosis?

The standard treatment for aortic stenosis is open heart surgery where the aortic valve is replaced. There are two types of valves that can be placed in a patient: a mechanical valve and a tissue (or bioprosthetic) valve. The tissue usually comes from pig tissue called a “porcine” valve. Mechanical valves last longer, so they may be recommended for patients who are younger. Patients who have mechanical valves must take a medication called warfarin to prevent the formation of blood clots on the valve.

A new treatment for aortic stenosis that does not involve open heart surgery is called Transcatheter Aortic Valve Replacement (TAVR). This procedure is done through plastic tubes (called catheters) that are inserted through needles into the blood vessels in the groin. The procedure resembles a balloon angioplasty in which a catheter is threaded through an artery and a balloon device on the end inflates to help open up a narrowing in an artery in the heart. In a TAVR, the replacement valve collapses to a very small diameter and is crimped onto the balloon device. The physician positions the replacement valve inside the patient's natural aortic valve and inflates the balloon. This causes the replacement valve to expand, pushing the faulty valve aside. The replacement valve begins to function as soon as the balloon catheter deflates to permit the flow of blood.

This approach is generally recommended for patients who are not suitable candidates for open-heart surgery. In a TAVR, a replacement valve is placed at the site of the old valve after the old valve has been opened with a balloon. This treatment is available through USF Cardiology.